ABSTRACT
Objective To explore the clinical efficacy of single-port Da Vinci robotic surgical system in the radical resection of rectal cancer.Methods The retrospective descriptive study was conducted.The clinical data of one patient with rectal cancer who was admitted to the Southwest Hospital of the Third Military Medical University in June 2017 was collected.The patient underwent the first case of radical resection of rectal cancer with the single-port la Vinci robotic surgical system,and intraoperatively received laparoscopy-assisted digestive tract reconstruction.Observation indicators:(1) intra-and post-operative situations;(2) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to July 2017.Results (1) Intra-and post-operative situations:the patient underwent successful single-port Da Vinci robotic radical resection of rectal cancer.The operation time and volume of intraoperative blood loss were 145minutes and 20 mL,without blood transfusion.The using time of nonsteroidal analgesic drug,time for out-of-bed activity,time to anal exsufflation,time of fluid diet intake and time of pelvic drainage tube removal were 1 day,24hours,48 hours,72 hours and 4 days after operation,respectively.No postoperative complication was detected.Results of postoperative pathological examination:moderate-differentiated rectal adenocarcinoma invaded serosal layer,with negative circumferential margin,negative distal margin of rectum and mesenteric lymph node metastasis (1 of 16 harvested lymph nodes was positive).Pathologic staging was T4aN1M0 (stage Ⅲb).The patient was discharged from hospital at postoperative day 6.(2) Follow-up and survival:the patient was followed up for 1month,with a good survival.Conclusion Single-port Da Vinci robotic surgical system in the radical resection of rectal cancer is safe and feasible,with good short-term outcomes.
ABSTRACT
Objective To compare the clinical efficacy of Da Vinci robot-assisted esophagectomy and combined thoracoscopy-and laparoscopy-assisted esophagectomy for esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 116 patients who underwent minimally invasive radical resection of esophageal cancer in the Shanghai Chest Hospital of Shanghai Jiaotong University between November 2015 and September 2016 were collected.Fifty-eight patients undergoing combined thoracoscopy-and laparoscopy-assisted esophagectomy and 58 undergoing Da Vinci robot-assisted esophagectomy were respectively allocated into the thoracoscopy-and laparoscopy-assisted and Da Vinci robot-assisted groups.Patients received esophagectomy by right thorax-left cervico-abdominal triple incisions,thorax-cervico 2-field lymph node dissection of esophageal cancer and digestive tract reconstruction via assisted incision.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were described as (x)±s.Measurement data with skewed distribution were described as M (range).Comparison between groups was analyzed by the nonparametric test,and comparisons of count data were done by the chi-square test and Fisher's exact probability.Results (1) Surgical and postoperative situations:all patients received successful surgery,without conversion to open surgery.The number of lymph nodes dissected along the recurrent laryngeal nerve (RLN) and duration of postoperative hospital stay were 2.8±2.2,13 days (range,9-131 days) in the thoracoscopy-and laparoscopy-assisted group and 4.8±3.7,11 days (range,7-81 days) in the Da Vinci robot-assisted group,respectively,with statistically significant differences between the 2 groups (t =3.480,Z =2.361,P＜0.05).The total operation time,numbers of patients with overall complications,anastomotic leakage,injury of the RLN,pleural effusion,pulmonary infection,respiratory failure,chylothorax,arrhythmia and tracheoesophageal fistula were respectively (276±61)minutes,24,15,7,6,5,4,2,1,0 in the thoracoscopy-and laparoscopy-assisted group and (261±50)minutes,21,8,10,4,2,2,1,1,1 in the Da Vinci robot-assisted group,with no statistically significant difference (t =1.296,x2 =0.327,2.657,0.620,0.438,1.368,0.703,0.342,1.009,P＞0.05).Some of the patients had postoperative multiple complications.Patients with anastomotic leakage received local dressing changes,continuous gastrointestinal decompression and vacuum aspiration.The pronunciation and bucking response were observed in patients with injury of the RLN (unilateral injury).Patients with pleural effusion received pleural puncture fluid or closed thoracic drainage.Patients with pulmonary infection underwent antibiotic therapy and regular aerosol inhalation.Patients with respiratory failure underwent tracheotomy and assisted breathing with ventilator.Patients with chylothorax received fasting and closed thoracic drainage.Patients with arrhythmia were treated by drug.Patients with tracheo-esophageal fistula underwent conservative treatment.All the patients with complications were improved or cured.There were no wotmd infection,deep venous thrombosis of lower extremity,pulmonary embolism,reoperation and death within 30 days postoperatively in patients of 2 groups.(2) Follow-up and survival situations:all the 116 patients were followed up for 5-15 months,with a median time of 8 months.Numbers of patients with tumor-free survival,tumor recurrence and tumor metastasis were 50,6,4 (2 with simultaneous tumor recurrence and metastasis) in the thoracoscopy-and laparoscopy-assisted group and 51,5,4 (2 with simultaneous tumor recurrence and metastasis) in the Da Vinci robot-assisted group,respectively,showing no significant difference between the 2 groups (x2=0.077,1.000,P＞0.05).Conclusions Da Vinci robot-assisted esophagectomy is safe and feasible in the treatment of esophageal cancer.Compared with combined thoracoscopy-and laparoscopy-assisted esophagectomy,Da Vinci robot-assisted esophagectomy has comparable operation time,and is associated with a greater yield of lymph nodes along the RLN.